|
HC LIVER IMAGING - NM LIVER
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
3417820101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$77.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$320.38
|
|
|
HC LIVER IMAGING - NM LIVER
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
3417820101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC LIVER IMAGING WITH FLOW - NM LIVER WITH VASCULAR FLOW
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
3417820201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$376.40
|
|
|
HC LIVER IMAGING WITH FLOW - NM LIVER WITH VASCULAR FLOW
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
3417820201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC LIVER & SPLEEN IMAGE, FLOW - NM LIVER SPLEEN WITH VASCULAR FLOW
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78216
|
| Hospital Charge Code |
3417821601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$306.67
|
|
|
HC LIVER & SPLEEN IMAGE, FLOW - NM LIVER SPLEEN WITH VASCULAR FLOW
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78216
|
| Hospital Charge Code |
3417821601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LOOP RECORDER EVAL ADJUST - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93285
|
| Hospital Charge Code |
4809328501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC LOOP RECORDER EVAL ADJUST - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93285
|
| Hospital Charge Code |
4809328501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC LOOP RECORDER INTERROGATE - IN PERSON
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 93291
|
| Hospital Charge Code |
4809329101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$34.17
|
| Rate for Payer: AlohaCare Medicare |
$34.17
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$37.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.95
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$34.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.17
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.17
|
| Rate for Payer: University Health Alliance Commercial |
$88.20
|
|
|
HC LOOP RECORDER INTERROGATE - IN PERSON
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 93291
|
| Hospital Charge Code |
4809329101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
HC LUMBAR PUNCT/ P-RX
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
4506232901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,342.60 |
| Max. Negotiated Rate |
$2,673.32 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
|
|
HC LUMBAR PUNCT/ P-RX
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
4506232901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,673.32 |
| Rate for Payer: AlohaCare Medicaid |
$833.89
|
| Rate for Payer: AlohaCare Medicare |
$833.89
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Devoted Health Medicare |
$917.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$833.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,618.20
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: Humana Medicare |
$833.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,736.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$833.89
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$917.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$833.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$833.89
|
| Rate for Payer: University Health Alliance Commercial |
$2,008.85
|
|
|
HC LUNG PERFUSION DIFFERENTIAL - NM QUANT DIFF PULMONARY PERFUSION
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78597
|
| Hospital Charge Code |
3417859701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$298.33
|
|
|
HC LUNG PERFUSION DIFFERENTIAL - NM QUANT DIFF PULMONARY PERFUSION
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78597
|
| Hospital Charge Code |
3417859701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$112.92 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$409.89
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LUNG PERF&VENTILAT DIFERENTL - NM QUANT DIFF PULMONARY PERFUSE VENT
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78598
|
| Hospital Charge Code |
3417859801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$248.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$649.90
|
|
|
HC LUNG PERF&VENTILAT DIFERENTL - NM QUANT DIFF PULMONARY PERFUSE VENT
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78598
|
| Hospital Charge Code |
3417859801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENT GAS REBREATH WASHOUT MULT
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$399.79
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENT GAS REBREATH WASHOUT MULT
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENT GAS REBREATH WASHOUT SINGLE
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857904
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENT GAS REBREATH WASHOUT SINGLE
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857904
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$399.79
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL MULTIPLE
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857902
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL MULTIPLE
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857902
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$399.79
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL SINGLE
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$399.79
|
|
